Recent changes to OHIP+
As of April 1, 2019 children and youth 24 years of age or younger who have drug coverage under a private insurance plan will no longer receive coverage through OHIP+. Children and youth who do NOT have private insurance will still claim through the provincial plan.
Private insurance is defined as any type of private plan, program or account which could contribute to the cost of any drug product, regardless of whether:
- the private insurance plan covers the particular drug for which coverage is sought;
- the child or youth or another person captured under the private insurance plan is required to pay a co-payment, deductible, or premium; or,
- the child or youth has reached their annual maximum under the private insurance plan and no further coverage is available.
What does this mean?
Insurance carriers have reverted back to pre-OHIP+ practices.
Ontario residents under age 25 have to submit their drug claims to their private drug plan, if applicable.
Individuals or families who have significant out-of-pocket costs, despite having private insurance coverage, can apply for additional financial support through the Trillium Drug Program. They cannot submit any out-of-pocket expenses to OHIP+.
How does it work?
Pharmacists will ask patients under age 25 if they have private insurance. If they have any form of private coverage in place, claims will be sent to the insurer. If no private coverage is in place, claims will be paid by OHIP+.
If patients have been approved for an EAP (Exceptional Access Program) or LU (Limited Use) drug through OHIP+, Manulife will grandfather the approval. A patient can provide proof of coverage through a pharmacy receipt or an approval letter from OHIP.
All changes will be reviewed with each respective renewal. We are not planning any off-renewal adjustments.
Contact your Manulife sales representative or back office as appropriate. Additional information about OHIP+ is available on the Ontario government website.